Utilization Management Nurse Consultant

CVS Health

. Review and assess clinical information to support coverage determinations and recommendations .

Posted 11/5/2026full-timeRemote • Florida • United StatesJuniorMid-Level💰 $26 - $75 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in clinical assessment and utilization management, applying evidence-based criteria to support coverage determinations while collaborating effectively with interdisciplinary teams. Proficient in navigating electronic health records and utilizing technology to enhance care coordination and member outcomes.

Highest-signal resume keywords

Active RN LicenseUtilization Management ExperienceCritical Care ExperienceStrong Communication SkillsMicrosoft Office 365 Proficiency

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical AssessmentEvidence-Based Criteria ApplicationCare CoordinationQuality Improvement IdentificationMed-Surg ExperienceCritical ThinkingComputer NavigationEHR Portal NavigationTechnical TroubleshootingInternet Speed Management

Soft Skills

CollaborationAdaptabilityTime ManagementOpenness to LearningProblem Solving

Tools & Technologies

Microsoft Office 365Google WorkspaceVPNTeams MessagingVirtual Meeting Platforms

Certifications & Qualifications

RN LicenseBSN Preferred

Industry Keywords

Utilization ManagementManaged CareHIPAA ComplianceAdult Acute CareCritical Care Setting

About the role

Key responsibilities & impact

Review and assess clinical information to support coverage determinations and recommendations
Apply evidence-based clinical criteria, policies, and professional judgment across the continuum of care
Collaborate with providers and interdisciplinary teams to coordinate care and promote positive member outcomes
Identify opportunities for quality improvement, care integration, and effective benefit utilization
Serve as a clinical resource for internal and external stakeholders
Work remotely as part of CVS Health’s Utilization Management team
Operate within a 24/7 service requiring potential evening, weekend, and holiday schedules

Requirements

What you’ll need

Active, unrestricted RN license in your state of residence
Minimum 2 years of RN experience in an adult acute care or critical care setting
Associates degree in nursing
2+ years of Med-Surg or specialty clinical experience preferred
Utilization Management and/or Managed Care experience preferred
Strong communication, critical thinking, and computer navigation skills
Ability to thrive in a fast-paced environment and manage multiple priorities
Candidates located in the Eastern Time Zone are strongly preferred
BSN preferred
Ability to work evenings, weekends, and holidays as schedules may include them
Direct/hardwired internet connection to a modem/router within 7 feet of the computer
Minimum internet speed of 25 mbs download and 3 mbs upload
Quiet, secure, private designated home workspace compliant with CVS Health and HIPAA guidelines
Work within the state and city where currently residing
Ability to use multiple monitors and navigate multiple applications
Ability to use email, calendar invites, Teams messaging, and virtual meetings
Experience with Microsoft Office 365 applications or similar Google Workspace tools
Ability to log in to secure systems such as VPN and EHR portals
Ability to manage strong passwords and recognize suspicious emails or links
Ability to troubleshoot common technical issues independently
Openness to learning new skills as the workplace environment evolves

Benefits

Comp & perks

Work remotely
Company-provided equipment (keyboard, monitor, computer, headset, etc.)
Medical coverage
Dental coverage
Vision coverage
Paid time off
Retirement savings options
Wellness programs
Other resources supporting physical, emotional, and financial well-being
CVS Health bonus, commission or short-term incentive program in addition to base pay range